Endometriosis is the ectopic location of functioning endometrial glands and stroma. Perianal endometriosis can present as a painful swelling and are usual mistaken as perianal abscess, thrombosed hemorrhoids, sebaceous cyst, or a resolving hematoma. The uncommon presentation delays the diagnosis and brings agony to the patient. Case description: A 34-year-old para 2, live 2 (P2L2), both uneventful vaginal deliveries, presented to our outpatient department with complaints of perianal pain for 3 years. Initially, the pain was more during her menstruation. Gradually it worsened and the patient started having severe noncyclical pain. There was no history of any obvious swelling or discharge from the perianal region. She gave a history of episiotomy given during her second delivery, 7 years back. There was also a history of perianal abscess drainage 2 years back. On local examination, there were no scars noted on the perineum. Per speculum and per vaginal examination were unremarkable. On per rectal examination, there were tenderness and induration noted at the 4 o'clock position. The patient was taken up for surgical exploration. The cyst wall was excised without any damage to the sphincter muscle and sent for histopathology. The histopathology report was suggestive of endometriosis. Conclusion: Since perianal endometriosis has varying clinical presentations, this condition has to be kept in mind especially when the patient has cyclical perianal pain.